4.19.2023 Board Book

Table 1 (part 4 of 5: Recommendations on management of obesity in adults*

Category of evidence and strength of recommendation†

Recommendations

Primary care and primary health care in obesity management 55 We recommend that primary care clinicians identify people with overweight and obesity, and initiate patient-centred, health-focused conversations with them. 56 We recommend that health care providers ensure they ask people for their permission before discussing weight or taking anthropometric measurements. 57 Primary care interventions should be used to increase health literacy in individuals’ knowledge and skill about weight management as an effective intervention to manage weight. 58 Primary care clinicians should refer persons with overweight or obesity to primary care multicomponent programs with personalized obesity management strategies as an effective way to support obesity management. 59 Primary care clinicians can use collaborative deliberation with motivational interviewing to tailor action plans to individuals’ life context in a way that is manageable and sustainable to support improved physical and emotional health, and weight management. 60 Interventions that target a specific ethnic group should consider the diversity of psychological and social practices with regard to excess weight, food and physical activity, as well as socioeconomic circumstances, as they may differ across and within different ethnic groups. 61 Longitudinal primary care interventions should focus on incremental, personalized, small behaviour changes (the “small change approach”) to be effective in supporting people to manage their weight. 62 Primary care multicomponent programs should consider personalized obesity management strategies as an effective way to support people living with obesity. 63 Primary care interventions that are behaviour based (nutrition, exercise, lifestyle), alone or in combination with pharmacotherapy, should be used to manage overweight and obesity. 64 Group-based diet and physical activity sessions informed by the Diabetes Prevention Program and the Look AHEAD (Action for Health in Diabetes) programs should be used as an effective management option for adults with overweight and obesity. 65 Interventions that use technology to increase reach to larger numbers of people asynchronously should be a potentially viable lower cost intervention in a community-based setting. 66 Educators of undergraduate, graduate and continuing education programs for primary health care professionals should provide courses and clinical experiences to address the gaps in skills, knowledge of the evidence, and attitudes necessary to confidently and effectively support people living with obesity. Commercial products and programs in obesity management 67 For adults living with overweight or obesity, the following commercial programs should achieve mild to moderate weight loss in the short or medium term, compared with usual care or education: • WW (formerly Weight Watchers) (level 1a, grade A) • Optifast (level 1b, grade B) 68 Optifast, Jenny Craig, WW (formerly Weight Watchers) and Nutrisystem should achieve a mild reduction of glycated hemoglobin values over a short-term period compared with usual counselling in adults with obesity and type 2 diabetes. 69 We do not recommend the use of over-the-counter commercial weight-loss products for obesity management, owing to lack of evidence. 70 We do not suggest that commercial weight-loss programs be used for improvement in blood pressure and lipid control in adults living with obesity. Emerging technologies and virtual medicine in obesity management 71 Implementation of management strategies can be delivered through Web-based platforms (e.g., online education on medical nutrition therapy and physical activity) or mobile devices (e.g., daily weight reporting through a smartphone application) in the management of obesity. 72 We suggest that health care providers incorporate individualized feedback and follow-up (e.g., personalized coaching or feedback via phone or email) into technology-based management strategies to improve weight-loss outcomes. 73 The use of wearable activity tracking technology should be part of a comprehensive strategy for weight management. • Jenny Craig (level 1b, grade B) • Nutrisystem (level 1b, grade B)

Level 3, grade C

GUIDELINE

Level 3, grade C

Level 1a, grade A

Level 1b, grade B

Level 2b, grade C

Level 1b, grade B

Level 1b, grade B

Level 1b, grade B

Level 1a, grade A

Level 1b, grade A

Level 1b, grade B

Level 1a, grade A

See recommendation

Level 1b, grade B

Level 4, grade D

Level 4, grade D

Level 2a, grade B

Level 4, grade D

Level 1a, grade A

CMAJ | AUGUST 4, 2020 | VOLUME 192 | ISSUE 31

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